20140584 Ver 2_Certification of Completion_20160301

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWFt Project No.: .Z.O l�105$ � V Z, Cowyty: � LqMArr�( e�
A�)rltCAllf: �(_l� C`5T � �Y % �__
Donald van der Vaarf
SecreEary
Project Name: � i�. I�! t�1�[ 5 IP�, 2 3�'T � ST,A L�.�% S'[�� �-��__INaS # � 7 i3P• �� 1Z. L� �
llate of Issuancc of 4(}1 Watcr Quality CcrfiEicAtion: � 2QS �'�Y
j� 1$__ __.._T
Certi�cate of Coni�lcfion
Upon CompleEion of all ���ork approved �vithin the 40l Water Quality Certification or appfic�ble L3uffer Rriles, and
a��y suUsec�tient i�iodifications, tlte a��plicaiyt is required to retur�� this eer€ificate to the 4Q1 Trai�s�ortation Peri�litti��g
Unit, North Caro3ina Divisio�� of Water Resources, IG50 Mail Service Center, Raleigh, NC, 27699-1650. This farm
�ttay be returned to NCDWR by tlie app[icaizt, tEie ap�licant's autE�orized abe��t, or tl�e project engineer. ]t is not
itecessary to send ce�Kificates f��o��� zil of tliese.
Appllca�tt's Cerlrflcalic»!
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� � �� , heE'eb state that to the best of m abilities due care and dili *ence
1, `�~' (,��^'1 � ,_ /; �'`..... y y � b
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was ttsed in the ob ervation of the construction sucl� tEiat the construction �vas observed to be biiilt within substantia[
con�pliance and i«tent of tlte 441 Wflter Quality CeE-tification and I3uffer Rules, tlte �ppE'oved �lans ai�d
specificatio�ts,_and atl�er sitppo�•ting materia[s.
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Signatu�e:..,� _ _�. �.. �`, �� / �..... Date: � �J
Age��t's Certlfrcafiot�
�� ,{�ereby state tklat, to the best of iliy abilities, dt�e care aiid diii�e�ace
�vas used in the observation of the canstruction such that Ehe corastructio�� was observed to ba built �vithii� substantial
complranca and i�ttent of tf�e 40l Water Qi�ality Ceitific�tion aE�d Buffer }7uEes, the approved plai�s �i3d
speciiications, and other sup}�orting n�aterials.
SigE�ature: __ _-,---- Date:
L�igrrreer's CertiJicatiu�!
Partial 1=i��a!
[, , as a duly registered Professional CE�giti�eer in the State of NorUi
Carolina, Etaving beeii audtorized to observe (periodically, �veekly, fi�ll time) the coiistructioi� of tEie project for titie
Permittee herel�y st�te that, to the best of c��y abilities, d�ie care aiid dil'sge�lce ws�s iEsed in tl�e abse+�vatioi� of tile
construction st�cl� tl�at the canstruction was observed to be bE�ilt within substa►ttial co�npliance �tnci ii�tent ofti�c �OE
Water Quality Certitication a�id Buffei� Rules, d�e �pproved ��fans and specifcatioc�s, and otlier su��p�arting materials.
Signature
Date
Registcation No.
16�7 Mail Servica Cenler, Rafeig�, Norih Carolina 27699•1617
Phone: [phone] InierneC www.ncdenr.gov
An Equa! Qpporiunity t A(6rmaGvo Action Employer